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Nakayama Y, Yamaguchi M, Inoue K, Sasaki M, Tamaki K, Hidaka M. Well-leg compartment syndrome after laparoscopic low anterior resection in the lithotomy position: a case report and literature review. J Surg Case Rep 2024; 2024:rjae206. [PMID: 38572283 PMCID: PMC10988823 DOI: 10.1093/jscr/rjae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Well-leg compartment syndrome (WLCS) develops in healthy lower limbs because of surgical factors such as operative position, lower limb compression, and long operative time during abdominopelvic surgery. WLCS can lead to irreversible muscle and nerve damage if a prompt diagnosis and appropriate treatment are not provided. We report the case of a 57-year-old male who developed rectal cancer immediately after laparoscopic low anterior resection and was successfully treated with fasciotomy without sequelae. Patients who undergo surgery in the lithotomy position for a prolonged period are at risk of WLCS. Therefore, when determining the differential diagnosis of postoperative lower leg pain, it is necessary to consider WLCS because it is a complication caused by the intraoperative position.
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Affiliation(s)
- Yoko Nakayama
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Minekazu Yamaguchi
- Faculty of Medicine, Department of General Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Keisuke Inoue
- Faculty of Medicine, Department of Digestive and General Surgery, Shimane University, 89-1, Enya-cho, Izumo City, Shimane 693-8501, Japan
| | - Masaki Sasaki
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Kaho Tamaki
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Masaaki Hidaka
- Faculty of Medicine, Department of Digestive and General Surgery, Shimane University, 89-1, Enya-cho, Izumo City, Shimane 693-8501, Japan
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Well-leg compartment syndrome after laparoscopic surgery for rectal cancer: A case report. Int J Surg Case Rep 2021; 86:106331. [PMID: 34464841 PMCID: PMC8408520 DOI: 10.1016/j.ijscr.2021.106331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Well-leg compartment syndrome (WLCS) develops from abnormal positioning of the limb during surgery. There have been few reports of WLCS in rectal cancer patients, although the lithotomy position, which is widely applied for rectal surgery, is a risk factor for WLCS. Case presentation A 56-year-old man with rectal cancer underwent laparoscopic low anterior resection of the rectum, left lateral lymph node dissection and diverting ileostomy. The operation time was 393 min. The patient was in the head-down tilt lithotomy position and rotated to the right side. Postoperatively, he complained of left lower leg pain and swelling and difficulty moving his legs. The compartment pressure of his right and left lower legs was 80 mmHg and 120 mmHg, respectively. A diagnosis of bilateral WLCS was made, and fasciotomy of both lower legs was performed 2 h after surgery. Although he was able to live his daily life, mild numbness remained in his toes one year after surgery. Clinical discussion In addition to risk factors previously reported for WLCS, our review shows that the male sex and left side are associated with a greater risk of WLCS, especially in rectal surgery. Additionally, our review reveals that the type of rectal surgery leading to WLCS is almost always laparoscopic surgery. Conclusion Surgeons should be especially vigilant for WLCS when they encounter patients, especially males, who complain of left lower leg pain after laparoscopic rectal surgery. Male sex, left leg, and laparoscopic are key factors for WLCS in rectal cancer. Leveling the patient every 3 h is important for prevention of WLCS. Surgeon's vigilance is vital for early diagnosis and resolution without sequela.
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Addley S, McMullan JC, Scott S, Soleymani Majd H. 'Well-leg' compartment syndrome associated with gynaecological surgery: a perioperative risk-reduction protocol and checklist. BJOG 2021; 128:1517-1525. [PMID: 33988902 DOI: 10.1111/1471-0528.16749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 12/01/2022]
Abstract
'Well-leg' compartment syndrome (WLCS) is an uncommon, but potentially devastating, complication associated with prolonged patient positioning for abdomino-pelvic surgery. Gynaecologists, anaesthetists and the wider theatre team share a responsibility to minimise the risk of this highly morbid, and even fatal, postoperative complication. This article provides an overview of WLCS related to gynaecological surgery - raising awareness amongst gynaecologists and highlighting the time-critical nature of diagnosis and management. Given the potential litiginous nature of this complication, we also present a perioperative checklist and risk-reduction protocol to suggest a standardised approach to prevention and relevant documentation. TWEETABLE ABSTRACT: Gynaecologists share a responsibility to minimise the risk of postoperative 'well-leg' compartment syndrome.
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Affiliation(s)
- S Addley
- Department of Gynaecology Oncology, Churchill Hospital, Oxford, UK
| | - J C McMullan
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Antrim, UK
| | - S Scott
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - H Soleymani Majd
- Department of Gynaecology Oncology, Churchill Hospital, Oxford, UK
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Anwer M, Banerjee N, Agarwal H, Kumar S. Compartment syndrome of the non-injured limb. BMJ Case Rep 2020; 13:13/4/e231657. [PMID: 32276995 DOI: 10.1136/bcr-2019-231657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Compartment syndrome is a common limb-threatening entity in trauma. However, the occurrence of the same in the non-injured limb is rare. It seems to be multifactorial in origin, with abnormal positioning being the most common cause. We present such a case of well-leg compartment syndrome which was treated by an urgent fasciotomy. We emphasise on the fact that the diagnosis of compartment syndrome is clinical and the management remains the same irrespective of whether the limb has sustained an injury or not.
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Affiliation(s)
- Majid Anwer
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Niladri Banerjee
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Harshit Agarwal
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Gill M, Fligelstone L, Keating J, Jayne DG, Renton S, Shearman CP, Carlson GL. Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery. Br J Surg 2020; 106:1156-1166. [PMID: 31304580 PMCID: PMC6772077 DOI: 10.1002/bjs.11177] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023]
Abstract
Background Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre‐existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Methods These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer‐reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. Results These guidelines encompass the risk factors (both patient‐ and procedure‐related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. Conclusion All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life‐changing complication.
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Affiliation(s)
- M Gill
- Department of Surgery, East Lancashire NHS Trust, Blackburn, UK
| | - L Fligelstone
- Department of Vascular Surgery, Swansea Bay University Health Board, Swansea, UK
| | - J Keating
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - D G Jayne
- Department of Surgery, University of Leeds, Leeds, UK
| | - S Renton
- Department of Surgery, Northwick Park Hospital, Harrow, UK
| | - C P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G L Carlson
- Department of Surgery, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
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Computed tomography angiography and magnetic resonance imaging performance of acute segmental single compartment syndrome following an Achilles tendon repair: A case report and literature review. Chin J Traumatol 2016; 19:290-294. [PMID: 27780511 PMCID: PMC5068145 DOI: 10.1016/j.cjtee.2016.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Acute compartment syndrome of the lower extremity is a serious postinjury complication that requires emergency treatment. Early diagnosis is of paramount importance for a good outcome. Four muscle compartments in the calf (anterior, lateral, deep posterior, and superficial posterior) may be individually or collectively affected. Acute segmental single-compartment syndrome is an extremely rare condition characterized by high pressure in a single compartment space with threatening of the segmental tissue viability. In this case report, we describe a young man with Achilles tendon rupture who complained of postoperative pain in the anterior tibial region. Emergent computed tomography angiography and magnetic resonance imaging revealed local muscle edema. Segmental anterior compartment syndrome was diagnosed and fasciotomy was performed.
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Enomoto T, Ohara Y, Yamamoto M, Oda T, Ohkohchi N. Well leg compartment syndrome after surgery for ulcerative colitis in the lithotomy position: A case report. Int J Surg Case Rep 2016; 23:25-8. [PMID: 27085103 PMCID: PMC4855417 DOI: 10.1016/j.ijscr.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Well leg compartment syndrome (WLCS) is an uncommon and severe complication that occurs after colorectal surgery in the lithotomy position. PRESENTATION OF CASE The current patient was a 28-year-old male suffering from ulcerative colitis. He was underwent elective proctectomy, including ileal J pouch formation and anal anastomosis with temporary loop ileostomy. The ileoanal pouch procedure was quite difficult, and during this procedure, the high lithotomy and head down tilt positions were continued for 255min. After the operation, the patient complained of severe cramping pain, swelling and serious tenderness on palpation in both legs. On the first postoperative day, the patient's complaints gradually worsened. The intra-compartmental pressure was measured, and WLCS was diagnosed. Emergency bilateral fasciotomy was performed. Initially, the patient had a sensory deficit and analgesia, however, his sensory disturbance and pain had almost recovered two months after fasciotomy by rehabilitation. DISCUSSION In the current case, the important factors associated with the development of WLCS are thought to be a prolonged operative time in which the patient is placed in the high lithotomy position during ileoanal pouch procedure. CONCLUSION We would thus like to emphasize that operations for the ileoanal pouch procedure to treat ulcerative colitis have a high potential for inducing WLCS, because it usually requires a prolonged operative time in which the patient remains in the high lithotomy position.
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Affiliation(s)
- Tsuyoshi Enomoto
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yusuke Ohara
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Masayoshi Yamamoto
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba-shi, Ibaraki-ken 305-8558, Japan.
| | - Tatsuya Oda
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Nobuhiro Ohkohchi
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
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Mizuno J, Takahashi T. Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position. Ther Clin Risk Manag 2016; 12:305-12. [PMID: 26955278 PMCID: PMC4772916 DOI: 10.2147/tcrm.s86934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Well-leg compartment syndrome (WLCS) is one of the catastrophic complications related to prolonged surgical procedures performed in the lithotomy position, using a knee-crutch-type leg holder (KCLH) system, to support the popliteal fossae and calf regions. Obesity has been implicated as a risk factor in the lithotomy position-related WLCS during surgery. In the present study, we investigated the relationship between the external pressure (EP) applied to the calf region using a KCLH system in the lithotomy position and selected physical characteristics. Methods Twenty-one young, healthy volunteers (21.4±0.5 years of age, eleven males and ten females) participated in this study. The KCLH system used was Knee Crutch®. We assessed four types of EPs applied to the calf region: box pressure, peak box pressure, contact pressure, and peak contact pressure, using pressure-distribution measurement system (BIG-MAT®). Relationships between these four EPs to the calf regions of both lower legs and a series of physical characteristics (sex, height, weight, and body mass index [BMI]) were analyzed. Results All four EPs applied to the bilateral calf regions were higher in males than in females. For all subjects, significant positive correlations were observed between all four EPs and height, weight, and BMI. Conclusion EP applied to the calf region is higher in males than in females when the subject is supported by a KCLH system in the lithotomy position. In addition, EP increases with the increase in height, weight, and BMI. Therefore, male sex, height, weight, and BMI may contribute to the risk of inducing WLCS.
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Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja-shi, Okayama, Japan
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Hori D, Noguchi K, Nomura Y, Lefor A, Tanaka H. Small incision fasciotomy in a patient with compartment syndrome and peripheral arterial occlusive disease. Ann Thorac Cardiovasc Surg 2012; 19:234-8. [PMID: 23232306 DOI: 10.5761/atcs.cr.12.01904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 82-year-old-man with a previous history of atrial fibrillation was admitted with acute limb ischemia. Emergent embolectomy was performed, but after the operation, the patient suffered from recurrent ischemic pain. Peripheral angiography revealed thrombosis of the distal popliteal artery due to pre-existing peripheral arterial occlusive disease. Bypass surgery of the popliteal artery and posterior tibial artery was then performed. Although peripheral blood flow was restored after the operation, he suffered from compartment syndrome the next day. The patient was treated with an emergent bed-side fasciotomy using a small incision, achieving full recovery of blood flow to the distal artery. The wound closed secondarily without surgical closure. In a patient with peripheral arterial occlusive disease, fasciotomy should be performed at a lower compartment pressure due to a lack of peripheral perfusion pressure. Emergent small incision fasciotomy was effective in this patient with an acute compartment syndrome and an ischemic limb.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Showa University, Fujigaoka Hospital, Kanagawa, Japan.
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Sajid MS, Shakir AJ, Khatri K, Baig MK. Lithotomy-related neurovascular complications in the lower limbs after colorectal surgery. Colorectal Dis 2011; 13:1203-13. [PMID: 20478008 DOI: 10.1111/j.1463-1318.2010.02314.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To review the literature on lithotomy-related neurovascular complications (LRNVC) of the lower limbs after colorectal surgery. METHOD Electronic databases were searched for relevant articles, including Medline, EMBASE, Pubmed, CENTRAL and CINHL. RESULTS LRNVC after prolonged lithotomy position during colorectal surgery can be classified into vascular, neurological and neurovascular combined. Compartment syndrome (CS) is the most common clinical presentation. Seven case reports and 10 case series on 34 patients (27 men, 6 women) with CS have been reported. Risk factors included the lithotomy position and duration of surgery of more than 4 h. CONCLUSION In colorectal surgery, lower limb LRNCVs, and CS are rare. A high index of clinical suspicion and early decompression may reduce morbidity.
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Affiliation(s)
- M S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK.
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Abstract
AIM In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. METHOD A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. RESULTS A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. CONCLUSION Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care.
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Affiliation(s)
- M M Rao
- The John Goligher Colorectal Unit, Leeds General Infirmary, Leeds, UK.
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Compartment syndrome of leg following total lumbar disc replacement via anterior retroperitoneal approach: a rare complication of anterior spinal surgery. Spine (Phila Pa 1976) 2010; 35:E74-6. [PMID: 20075765 DOI: 10.1097/brs.0b013e3181ca7331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational study of a case with a rare complication of lower limb compartment syndrome following total lumbar disc replacement via anterior retroperitoneal approach. OBJECTIVE To describe a patient with lower limb compartment syndrome, following total lumbar disc replacement via anterior retroperitoneal approach. SUMMARY OF BACKGROUND DATA Compartment syndrome is a rare complication of spinal surgery. Previously, there were very few reported cases of compartment syndrome following posterior approach through a knee chest position. We are reporting the first case of lower limb compartment syndrome following total lumbar disc replacement through anterior retroperitoneal approach. METHODS Case report and literature review. RESULT Total lumbar disc replacement through anterior retroperitoneal approach led to a vascular complication (left iliac vein injury) with failed attempt at surgical repair. At 48 hours, the patient developed left lower limb compartment syndrome. Surgical decompression of the compartment prevented serious sequel with a successful outcome. CONCLUSION Total disc replacement in the lumbar spine complicated with an acute compartment syndrome due to the left common iliac vein injury is reported for the first time. A vigilant postoperative work-up in an unconscious patient resulted in the diagnosis and decompression with a successful outcome.
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Liao KP, Gaut J, Huang AJ, Cohen G. A 20-year-old man with right leg pain following orofacial surgery. ARTHRITIS AND RHEUMATISM 2008; 59:1527-1532. [PMID: 18821652 DOI: 10.1002/art.24121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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